Changing policy to tackle age based disparities in haemato-oncological treatment

Elderly patients should be treated by biological age rather than chronological age according to speakers at Europe’s largest geriatric oncology meeting, 18-19th March, Rome. Leading experts from clinical, research, patient advocacy and policy fields met in Rome to discuss the state of the art and current clinical challenges in the field of haemato-oncology.

Elderly patients are currently under-treated in everyday clinical practice and under-represented in clinical trials. Both clinical and policy shifts were discussed to tackle this problem as well as myelodysplasia, anaemia, toxicities, co-morbidities and individualized management.

The inclusion of elderly patients in clinical trials is now one of the priorities of the European Union, represented by Beatrice Lucaroni, Head of the Health Directorate Medical Research Unit.

Lucaroni described various EU funded projects for delivering the best possible access of health care to the elderly, with over €750,000 funding, invested in projects such as the Consortium on Health and Aging Network of Cohorts in Europe and the united States (CHANCES). Lucaroni also talked about the PREDICT project, in which she is actively involved. Focusing on human development and ageing, it is aimed at shedding light on the situation of clinical trials in the elderly, and the unjustified criteria of exclusion of elderly patients from trials. Lucaroni also looked to the future, presenting a pilot innovation partnership on active and healthy ageing aimed at increasing the average number of healthy years by two, and made a plea for geriatricians from the audience to participate as experts and evaluators. “Ageing is the future of innovation, and Europe wants to be at the forefront”, she concluded.

Lucia Travado, Lisbon Hospital Centre, covered the psychosocial aspects of geriatric oncology, and presented data showing that psycho-social morbidities actually impact on the patient in several negative ways, by deteriorating quality of life, reducing compliance to treatment and efficacy too. As elderly patients are very heterogeneous, there is a need to tailor and assess each individual.

Some psychological treatments include, educational interventions and counselling, individual psychotherapy, and cognitive behavioural therapy. The issue of elderly patients complying with treatment, and the need to bring it to the fore was touched on by Giora Sharf, a chronic myeloid leukaemia survivor and head of the CML Advocates Network. Sharf showed very interesting data indicating that drug packaging affects compliance and worsens clinical outcome. For example, a recent study showed that more than 41% of patients were unable to open pills due to packages designed for child safety.

Sharf pointed out that though the compliance issue was only “scratched upon” in the meeting, it was the tip of the iceberg, being an issue that doctors need to discuss with caregivers and patients alike, as many do not understand the severe consequences of not taking the drug.

The awareness and sensitivity of the audience to this problem was raised during the two days of the forum, as shown by the interactive poll results. The number of attendees who would talk about compliance with their patient rose from 45% at the start of the meeting to 68% at the end. Other interesting shifts in perspective included over half the attendees, compared to an initial quarter, agreeing that the definition of elderly depends on biological not chronological age.

A consensus was also reached that cancer is not actively managed in the older patients and that stronger collaboration between haematologists and geriatricians is needed. The majority agreed that the best strategy to achieve this is the interdisciplinary management of patients from diagnosis to prognosis and follow up.

The meeting ran 18-20th March.

To view some of the topics covered and researchers involved click here: